Healthcare Provider Details

I. General information

NPI: 1467795575
Provider Name (Legal Business Name): ADAM MICHAEL O'TOOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 S FAIR OAKS AVE FL 1
PASADENA CA
91105-2606
US

IV. Provider business mailing address

542 S FAIR OAKS AVE FL 1
PASADENA CA
91105-2606
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-8910
  • Fax: 626-449-2155
Mailing address:
  • Phone: 626-449-8910
  • Fax: 626-449-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMED-PHYS-LIC-117418
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number51129
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA170617
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA170617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: